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Back in the 1960s I processed health insurance claims. Employees came to me with their receipts and I helped them put a claim together and then submit it for payment.
One day an employee presented a receipt from a hardware store- for rat poison. I thought it was a mistake or a joke. I almost laughed. However, he was quite serious. Rat poison is a blood thinner and it was prescribed by his doctor. Unfortunately, it wasn’t eligible for reimbursement. Good thing it was only a dollar or so. Heck, an office visit was $5.00. That would be $52 today – good luck with that.
As crude as that may seem today, apparently it did the job- very affordably. Just imagine getting your health care at Home Depot instead of Walgreens.
Today we know better. We even have a choice of drugs to accomplish the same thing as rat poison- except kill rats – at a price, of course.
The cost of popular blood thinners like Eliquis and Xarelto can vary significantly, with a 30-day supply potentially costing around $550 to $600.
Older blood thinners like Warfarin can be significantly cheaper, around $20 to $30 per month. Warfarin was developed in the 1920s as a result of research on cows dying from a blood thinning disease. Just like we do to rats.
You can get D-Con rat pellets for $8.64 at Walmart, but not Walgreens.
No, I’m not serious.
The thing with health care is we tend to want the latest of and perceived best of everything, regardless of cost as long as someone else is paying.
I recently read a woman’s rant on social media complaining that she incurred a $3,000 expense because the insurance company “refused to pay.” It was her deductible, but she didn’t see it that way. She expected 100% coverage.
Also, the way we use health care is not driven by demand, but by supply. More competition does not lower prices, it increases utilization.
Let’s say a new scanning/MRI center opens a mile away from an existing facility. It invests a million or more into equipment. The goal is not to attract with lower prices, but simply to do more MRIs.
The United States has 37.98 MRI units per million population. The second highest in the world. Everyone has to be paid for. The UK has 8.6 MRI scanners per million people, which is fewer than the average of 12.4 in the EU.
Your doctor is likely paid by private insurance, Medicare and Medicaid. What each pays for the same service is in that declining order. A practice couldn’t survive on what Medicaid or even Medicare pays. So guess what happens to other prices and utilization?
A 2017 study found that physicians themselves estimated that around 20.6% of overall medical care was unnecessary. A 2019 study in the Journal of the American Medical Association estimated that roughly 25% of total healthcare spending in the U.S. is wasteful.
Even competition among insurance companies is backwards. Too many competitors doesn’t lower premiums in an area, it dilutes their ability to negotiate lower fee payments because their ability to deliver patients is lessened.
It seems that all we know about economics doesn’t apply to health care. I chalk that up to the people expectation factor.
The disparity of drug prices is mind boggling. Other countries, including Canada pay far less for drugs than the US. I would like to see RFK force big pharma to give Americans more comparable pricing, especially with other Western nations.
Consumers in the US are definitely not good stewards of health care. When our organization starting using copays, one of our admins said she would not go to doc to avoid paying the copay. Hmmm, I believe that was the intent.
I’m just counting my blessings over here, since my health insurance makes me money every year (so far) 😁
I have been on warfarin for 25 years, and will be on it for the rest of my life. (I had a heart valve replacement in 2000.) For some reason, these newer anti-coagulants are not appropriate for me.
Prior to going off patent, warfarin was expensive (at least $100 per month, as I recall). I once asked my cardiologist, jokingly, if I could take rat poison instead. He said I could. However, he did not recommend it. With rat poison, kernels of corn are covered with warfarin. But he said the mg. of warfarin per corn kernel was not consistent.
Currently I pay $-0- per month for my Medicare drug plan. (I have no idea how that is possible.) I also pay $-0- for a 90-day supply of warfarin.
Yes, I am supposed to get a blood test every four weeks. Because my blood “thinness” is so consistent, I go every five or six weeks. Also, because my primary care physician trusts me, I decide when to increase or decrease my dosage, and by how much. I do keep him informed of what I am doing. 🙂
Warfarin is a good example of the economic concept of price elasticity. When the price was $100 per month, I paid it. If the price had gone up to $1,000 per month, I still would have bought the same amount. (If I do not take warfarin consistenly, my life span is 10 to 15 years.) Even though my price has effectively dropped to zero, I don’t buy any more of it.
The issue of obtaining sufficient value for health care dollars spent is real and hugely important, but I don’t think the new generation of anticoagulants (popularly but incorrectly called blood thinners) is an example of poor value. I treated patients with warfarin when it was the only option, so I am familiar with the difficulties involved in doing it safely. Also, for 25 years I have been reading summaries of 2,000+ medical malpractice claims yearly for my malpractice prevention newsletter for physicians. In my experience, warfarin generated a hugely disproportionate share of serious injuries and malpractice claims. Those human and economic costs must be considered along with the price of the drug. The processes and systems required to manage warfarin safely for long periods of time are complicated, ongoing, and prone to errors. It requires a conscientious, motivated patient who will obtain regular blood tests to monitor the level of anticoagulation and make adjustments as instructed (which requires more time, additional costs of care beyond the price of the drug, and hassle for the patient not present with the newer anticoagulants), as well as the need to minimize interactions with diet and other drugs — and still the levels of anticoagulation can vary considerably in any one patient. All anticoagulants are dangerous, but the newer ones are significantly safer than warfarin: the doses are standardized, and the level of anticoagulation is more consistent and does not require monitoring with blood tests. I cannot remember seeing a single malpractice claim involving Eliquis and Xarelto except for the ones inherent to all anticoagulants, mainly stopping and restarting them around procedures and operations that pose a risk of dangerous bleeding. Warfarin can be taken relatively safely with a responsible patient and safe system of care, but the newer drugs are preferable. Xarelto is now available as a generic for less than $100/month.
I have read that about 5 percent of Caucasians in North America have a genetic blood defect named factor V Leiden (FVL). I believe FVL was first identified in 1994 in the city of Leiden and often people do not know they have the genetic defect until they have a life medical event that involves an unexpected blood clotting event. I expect that lack of awareness about if you have a FVL defect is still the prevalent status for the majority of people who have the genetic defect but not had such a medical event that involves a blot clot.
I do not have medical training or expertise, just experience with FVL. You can read about FVL at this link –
https://en.wikipedia.org/wiki/Factor_V_Leiden#:~:text=Factor%20V%20Leiden%20is%20the,laboratory%20of)%20Pieter%20Hendrik%20Reitsma.
In past years warfarin (aka as rat poison) seemed to be the primary out of hospital medication to try to control a re-occurrence of a subsequent blood clotting event. Newer drugs do not cause many of the problems that taking warfarin does. The cost of the newer drugs is often a major consideration.
Don’t take medical advice from a blog post by me. If in doubt about your FVL status please talk to a knowledgeable medical professional.
A year or so back my sister in law called my wife and me (we are both retired medical professionals) because she started experiencing a swollen calf without any precipitating circumstances. We explained to her that she may have a blood clot and needed to go to the ER immediately. She kept dismissing the possibility so finally I said the quiet part out loud, “ IT COULD KILL YOU.” Then for good measure I asked her if she wanted to see her grandchildren grow up.
Those two declarations woke her up. She went to the ER and sure enough she had a blood clot. Recently she underwent the genetic testing and was positive for the genetic mutation. Her brother also has the defect. That is two of seven siblings to date.
I had been out of clinical practice so was unaware of the test, but was aware of the serious consequences of passing off unexplained pain, swelling, shiny skin, or warmth to touch in someone’s calf.
Retired Hematologist here. I cannot begin to describe or explain how horrible treating patients with warfarin was. Anybody who requires anticoagulation today is profoundly lucky that they have access to the newer anticoagulants available.
I wonder why it’s still on the market.
Good question! Keeping in mind that I’ve been retired for four years and things change : there are certain indications for anticoagulation that Coumadin is still the drug of choice because the newer agents have not yet been approved and/or been studied to know if they are as effective as warfarin.
Fyi: coumadin (trade name) and warfarin (generic name) = same drug.
Our expectations, while huge, are one of many factors in the cost of healthcare. For example, many doctors are employees these days, and under pressure to increase their production. Am I wrong to say that administrative costs in the U.S. is more than other countries?
Rat poison though? Who-da-ever-thunk that? Maybe bleach isn’t such a crazy idea after all!
The figures I usually see are that the cost of US health care, per person, is about double that in other industrialized countries. Some of that is more expensive procedures (other countries don’t do routine colonoscopies on low risk patients), but much of it is administrative. When I visited a doctor in France he had no back office staff at all.
1) the US spends twice as much per capita on healthcare, with much poorer results than other developed countries
2) 20% of all spending on healthcare is administrative.
That “much poorer results’ is complicated and not exactly accurate especially when referencing the health care we receive.
What about the health care “we” don’t receive?
Take a look at the maternal and infant mortality figures and then tell me how good US health care is.
Sometimes we receive too much “healthcare”, This suggests that 25% of Medicare costs go for care in the last year of life.
Re : Sometimes we receive too much “healthcare”, This suggests that 25% of Medicare costs go for care in the last year of life.
This is completely accurate from my reading.
Yes, look at those infant figures and then look at where the problems are grouped and why. It’s not the health card alone. We need to be clear on the difference between the system and the actual care provided. Two separate, but clearly related issues. Have you ever actually received poor health care in the US.
I haven’t (yet) needed a lot of health care but I have twice avoided overly aggressive health care by getting a second opinion. I avoided lifelong statins by changing my diet. When I was hospitalized with double pneumonia I got myself moved to a different hospital after the third medical error.
I have avoided unnecessary colonoscopies by first fecal-occult testing and more recently Cologuard (much cheaper and non-invasive, therefore safer.)
Very quick Google search ALL of which have the same reply:
On a per person basis, U.S. health spending is nearly double that of similarly large and wealthy nations, on average. In 2023, the U.S. spent over $3,500 more per capita on healthcare than the next highest spending country, Switzerland. Meanwhile, the U.S. has the lowest life expectancy among peer countries.
More about lifestyles of Americans than the actual care provided? How do we live that requires all the health care?
We don’t necessarily need “all the health care”. In a fee for service system providers are motivated to deliver the maximum care they can justify. And don’t forget how much of that cost is for middlemen, administration and profit.
On average doctors or practices deal with seven different health plans plus Medicare and Medicaid. No doubt that is a burden. I’m told Medicare is the easiest to deal with – they rarely question anything. It is more susceptible to fraud too.
Online patient systems help, but they rarely function beyond one group. We have linked all our bank across everything, but not health care records or billing. Go to three different doctors and you have to repeat all your information. It’s nuts, rats! 🐁